Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components.
Study Goal
The researchers aimed to assess the effectiveness of non-pharmacological self-management interventions, including mindfulness, compared to usual care for migraine and tension-type headache, and explore the impact of different intervention components and delivery methods.
Results Summary
The study found that mindfulness components in interventions had a larger effect on reducing pain intensity (SMD=-0.50) compared to interventions without mindfulness. Overall, self-management interventions, including mindfulness, were more effective than usual care in reducing pain intensity, improving mood, and decreasing headache-related disability, but had no effect on headache frequency.
Population
People living with migraine and/or tension-type headache
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Non-pharmacological educational or psychological self-management interventions | decrease | pain intensity | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of -0.36 (-0.45 to -0.26) | found a small overall effect for the superiority | #1 |
Non-pharmacological educational or psychological self-management interventions | decrease | headache-related disability | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of -0.32 (-0.42 to -0.22) | found a small overall effect for the superiority | #2 |
Non-pharmacological educational or psychological self-management interventions | increase | quality of life | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of 0.32 (0.20 to 0.45) | found a small overall effect for the superiority | #3 |
Non-pharmacological educational or psychological self-management interventions | decrease | mood | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of -0.53 (-0.66 to -0.40) | found a moderate effect | #4 |
Non-pharmacological educational or psychological self-management interventions | no change | headache frequency | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of -0.07 (-0.22 to 0.08) | did not find an effect | #5 |
self-management interventions that included explicit educational components | decrease | pain intensity | People living with migraine and/or tension-type headache | -0.51 (-0.68 to -0.34) vs -0.28 (-0.40 to -0.16) | suggests a larger effect | #6 |
self-management interventions that included mindfulness components | decrease | pain intensity | People living with migraine and/or tension-type headache | -0.50 (-0.82 to -0.18) vs -0.34 (-0.44 to -0.24) | suggests a larger effect | #7 |
self-management interventions delivered in groups | decrease | pain intensity | People living with migraine and/or tension-type headache | -0.56 (-0.72 to -0.40) vs -0.39 (-0.52 to -0.27) | suggests a larger effect | #8 |
self-management interventions including a cognitive-behavioural therapy (CBT) component | decrease | mood | People living with migraine and/or tension-type headache | standardised mean difference (SMD) of -0.72 (-0.93 to -0.51) compared with those without CBT -0.41 (-0.58 to -0.24) | suggests larger effects | #9 |
OBJECTIVES: To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions PARTICIPANTS: People living with migraine and/or tension-type headache INTERVENTIONS: Non-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache-related disability, quality of life and medication consumption in meta-analysis.We also provide preliminary evidence on the effectiveness of intervention components and delivery methods. RESULTS: We found a small overall effect for the superiority of self-management interventions over usual care, with a standardised mean difference (SMD) of -0.36 (-0.45 to -0.26) for pain intensity; -0.32 (-0.42 to -0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (-0.66 to -0.40)). We did not find an effect on headache frequency (SMD=-0.07 (-0.22 to 0.08)).Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (-0.51 (-0.68 to -0.34) vs -0.28 (-0.40 to -0.16)); mindfulness components (-0.50 (-0.82 to -0.18) vs 0.34 (-0.44 to -0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (-0.72 to -0.40) vs -0.39 (-0.52 to -0.27)) and larger effects on mood in interventions including a cognitive-behavioural therapy (CBT) component with an SMD of -0.72 (-0.93 to -0.51) compared with those without CBT -0.41 (-0.58 to -0.24). CONCLUSION: Overall we found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness. TRIAL REGISTRATION NUMBER: PROSPERO 2016:CRD42016041291.